| NPI | 1831596840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALONDA HARRIS Supervisor 704-499-2243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NC 25150000X) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2017-10-26 |